The results focus, first, on ‘order’ consultations, specifically who instigates blood testing, information sharing, and SDM. How GPs inform patients about blood test results, and how they promote patient understanding, were then explored. Who instigates blood testing? In the 36 ‘order’ consultations (including ‘order’ and ‘order and results’ consultations; hereafter referred to as ‘order’ consultations), no patients explicitly requested blood tests; however, 11 patients (31%) ‘hinted’ at wanting a blood test. Of these 11 examples, five hints came in the form of the patient reporting another doctor had suggested that a blood test might be beneficial, for example: ‘With my GP in London, I was talking about getting, maybe, tests, to see if there’s something wrong, kind of, hormonally … Of the 23 out of 36 ‘order’ consultations, for which patient pre-visit survey data on expectations were available, 11 patients (48%) had been expecting one or more ‘tests or investigations’ to be ordered, 10 (43%) were unsure, and two (9%) did not expect any to be ordered.
This compares with 62 (32%) of the 193 patients expecting ‘tests or investigations’ in the OiaM archive, for whom pre-visit expectations data were available. Of 11 patients expecting one or more ‘tests or investigations’ to be ordered, GlycoMode Glucose Support five (45%) went on to ‘hint’ at wanting a blood test. In five (14%) ‘order’ consultations, the GP used only generic terms, such as ‘blood tests’, to describe the tests to the patient, and gave no further detail. Table 2 describes the number of consultations in which there was any use of different referencing practices by the GP. GPs favoured naming specific tests, such as ‘cholesterol’, over naming groups of tests, such as ‘full blood count’; however, this was often at the expense of naming all included tests. GPs gave some explanation as to why the test was indicated in 29 (81%) of the 36 ‘order’ consultations. However, some explanations were very brief, such as: GP: ‘Is there anything else you wanted to talk about today?
Other explanations were more thorough: ‘… MOT. I shouldn’t use the term MOT, but, for example, checking cholesterol level, doing a diabetic check, maybe some simple blood counts, kidney, liver. In only six (17%) ‘order’ consultations did the GP give some explanation of the risks or limitations of the tests, such as the risk of false positives or negatives. Examples included the GP informing the patient there can be variation between laboratory results, that results of blood tests may be skewed by a cold (in reference to inflammatory markers), and explaining to a patient that inflammatory markers are non-specific and cannot determine whether inflammation is in the joints. The most extensive discussions about limitations were regarding prostate-specific antigen (PSA) testing. For example: ‘It can lead to more problems than less problems because, as you rightly say, sometimes the PSA can be raised and you can have nothing wrong with you.
If it comes back as moderately high, the moderate ones are the ones that are the most problematic. It probably means you’re OK, but you end up having a biopsy because it’s raised. If it’s sky-high, in the hundreds, then we know you’ve got something pretty much wrong with you. In only four (11%) ‘order’ consultations, did the GP explicitly offer any alternative option(s), including the option of no blood test, or an alternative test, for example, imaging. Of the consultations where more than one option was presented, half were regarding testing PSA, the other half were regarding screening for arthritis, and all were tests that the patient ‘hinted’ at: ‘It’s up to you. 60 years) ‘… I will give you a leaflet, just regarding the PSA, because I did rush through that, just so you can think about it. In 13 (36%) ‘order’ consultations, the patient did not ask any questions about the GlycoMode Blood Sugar support test, nor were they offered the opportunity to do so by the GP.